Provider Demographics
NPI:1477685626
Name:HAMPTON, TERRENCE THADDEUS (DMD DENTIST)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:THADDEUS
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:DMD DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:409 W MAIN ST
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055
Mailing Address - Country:US
Mailing Address - Phone:580-658-3619
Mailing Address - Fax:580-658-3619
Practice Address - Street 1:409 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLOW
Practice Address - State:OK
Practice Address - Zip Code:73055
Practice Address - Country:US
Practice Address - Phone:580-658-3619
Practice Address - Fax:580-658-3619
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist